Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; and Department of Rehabilitation Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan.
Department of Emergency and Critical Care Medicine, National Hospital Organization Nagasaki Medical Center, Omura, Japan.
Respir Care. 2024 Sep 26;69(10):1314-1322. doi: 10.4187/respcare.11777.
BACKGROUND: Recovery of walking independence in critically ill patients is required for safe discharge home. However, the pre-admission predictors affecting this outcome in this patient group are unknown. This study aimed to identify these predictors. METHODS: We included subjects who required mechanical ventilation for at least 48 h and could walk before admission. We investigated frailty, cognitive impairment, and malnutrition risk according to the pre-admission health status. Walking independence was defined as the ability to walk for at least 45 m on level ground. The primary outcome was the association between the time to event from an ICU discharge to walking independence, and pre-admission predictors were analyzed using a Fine-Gray proportional hazards regression. RESULTS: The rate of walking independence was 38.0 (100 cases/person-month; sample 144). In the proportional hazards regression model, adjusted for covariates, frailty (hazard ratio [HR] 0.08 [95% CI 0.01-0.67]), pre-frailty (HR 0.37 [95% CI 0.14-0.99]), cognitive impairment (HR 0.21 [95% CI 0.05-0.90]), and malnutrition risk (HR 0.20 [95% CI 0.07-0.58]) were associated with walking independence. CONCLUSIONS: Pre-admission frailty or pre-frailty, cognitive impairment, and malnutrition risk can help predict walking independence in critically ill patients who require mechanical ventilation.
背景：危重症患者需要恢复独立行走能力才能安全出院回家。然而，目前尚不清楚影响这类患者这一结局的入院前预测因素。本研究旨在确定这些预测因素。
方法：我们纳入了那些需要机械通气至少 48 小时且入院前能够行走的患者。我们根据入院前的健康状况调查了衰弱、认知障碍和营养不良风险。行走独立定义为能够在水平地面上行走至少 45 米。主要结局是从 ICU 出院到行走独立的时间事件与入院前预测因素之间的关联，使用 Fine-Gray 比例风险回归分析来分析预测因素。
结果：行走独立的比例为 38.0%（100 例/人月；样本量为 144 例）。在比例风险回归模型中，调整了协变量后，衰弱（风险比 [HR] 0.08 [95% CI 0.01-0.67]）、衰弱前期（HR 0.37 [95% CI 0.14-0.99]）、认知障碍（HR 0.21 [95% CI 0.05-0.90]）和营养不良风险（HR 0.20 [95% CI 0.07-0.58]）与行走独立相关。
结论：入院前衰弱或衰弱前期、认知障碍和营养不良风险可以帮助预测需要机械通气的危重症患者的行走独立性。
Respir Care. 2024-9-26
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